21/01/2019

Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.  

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Training Events

Information sharing/data

Knowledge Transfer

Mental Health

Acute and emergency care

Primary Care

Brexit

Prison Health

Children

Procurement

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Employment/HR

Regulation

Finance

Social care

Immigration

General

 

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Bevan Brittan Free Training Events 

Bevan Brittan Events

Litigants in person webinar - 22 January 12.30pm - 2pm. Litigants in person can present particular challenges in managing cases. Funding changes mean that such cases are increasing. Aidan O'Brien a barrister at Farrar's Building will review how to respond and how to strike the balance between firmness and fairness. If you would like to join this webinar please contact Claire Bentley. 

Bevan Brittan Digital Health Forum - 12 March 2019 London

Clinical Risk Webinars
Bevan Brittan Clinical Risk/Medical Law Training -
These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility. If you would like to receive notification of the webinars coming up just ask Claire Bentley.   

 

Knowledge Transfer

Training. In addition to our free training programme for 2019, we also provide bespoke knowledge transfer sessions on a range of healthcare law topics. If you wish to discuss any queries you may have around training or webinars please contact Claire Bentley.  

Early Intervention Scheme and Triage. Our EIS allows us to help commissioners, providers and care co-ordinators identify packages of care and treatment interventions, for people who lack capacity, that need an appropriate legal framework. If you would like more information click here.

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Acute and emergency care

Publications and guidance

Instant messaging The NHS has published new guidance to help CCGs and others to decide how and when to use instant messaging in acute clinical settings. 

Safety and learning video - Emma Redfern is a consultant in Emergency Medicine who played a part in saving Graham Papworth’s life back in 2014. They got together recently and made a short video titled ‘My Doctor and me’ for Aortic Dissection Awareness (UK & Ireland) and their UK Think Aorta Campaign. The video is designed to help spread best practice to emergency departments across the UK and globally. It covers some really great joined up team work between departments at UH Bristol, how together they save lives, their caring and professional interaction with the patient and their family and how the staff are trying to share knowledge.

Average attendance rates in A&E for alcohol poisoning. This data summary displays the volume and proportion of attendances with a diagnosis of alcohol poisoning. It also highlights that from 2016 through 2018, July 7 2018 was the busiest day for this diagnosis with just over 700 attendances.

If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley. 

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Brexit 

Publications/Guidance 

Brexit operational readiness guidance for the health and care system in England Actions that providers and commissioners of health and social care services should take to prepare for, and manage, the risks of a no-deal exit scenario.

Commissioners and providers of social care: Brexit planning update. Letters to commissioners and providers of adult social care giving an update on actions to consider in the period leading up to March.

EU Exit operational readiness guidance. The Government and the EU have now agreed the basis upon which the UK will leave the EU in March 2019. A ‘no deal’ exit is not the Government’s policy but they have a duty to prepare for all scenarios. They have published guidance detailing the actions the health and care system in England should take to prepare for a 'no deal' scenario. Accompanying the guidance is a cover letter.

Planning for a possible no-deal EU Exit: information for the health and care sector Guidance for industry and organisations involved in health and care about contingency plans for a no-deal Brexit.

EU exit operational readiness guidance: actions the health and care system in England should take to prepare for a 'no deal' scenario This guidance, developed and agreed with NHS England and NHS Improvement, will support the health and care system in England to be prepared for a no-deal scenario. It summarises the areas that the Department of Health and Social Care is focusing on in its no-deal exit contingency planning and those in which local action is required. Further operational guidance will be provided to support the health and care system to prepare for the UK leaving the EU before 29 March 2019.

Bevan Brittan Updates 

Brexit advice from Bevan Brittan. Bevan Brittan has brought together its expert legal and regulatory services advising on Brexit-related issues to create a new advisory service and information hub through which clients can access support and advice.

Procurement: Brexit – all bases covered? Despite the apparent political uncertainty, what is currently clear is that the rules governing public procurement will remain largely unchanged for the time being, meaning that contracting authorities will need to continue to advertise above threshold opportunities and follow a regulated procedure.

New Immigration Rules And Brexit Increase Recruitment Concerns.  Employers in the UK are facing serious challenges in recruiting the skilled people they need. With job vacancies now at a record high, there are concerns that – BREXIT deal or ‘no deal’ - a more restrictive immigration regime will lead to hiring and retention difficulties staying at critical levels for some time.

UK’s withdrawal from the EU – the coming days and what it could mean for businesses. The possibility of the UK leaving the EU without a deal has been a risk since 23 June 2016. The UK and EU policymakers have no doubt of how serious the consequences of a no deal would be for the UK and the EU’s 27 economies and business communities.

If you wish to discuss any queries you may have around Brexit please contact Adam Kendall

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Children 

Publications/Guidance 

Restraint Techniques: Children and Young People: Written question - 206310. In response to a written question asking for an update on when the Department plans to publish its response to its consultation on reducing the need for restraint and restrictive intervention, the Department of Health and Social Care stated that it has been working with Department for Education officials to refine the draft guidance following the public consultation and aims to publish the guidance in the Spring 2019.

Mental health services for children and young people: Seventy-Second Report of Session 2017-19 A Committee of Public Accounts report states that although there is a welcome focus on improving NHS mental health services for children and young people, there are still significant gaps in the data to monitor progress. It warns that most young people with a mental health condition do not get the treatment they need, and under current NHS plans this will still be true for years to come, while many face unacceptably long waits for treatment. It also notes that tackling mental health issues among children and young people requires significant cross-departmental co-operation, but current approaches do not ensure that this co-operation happens in practice.

Childhood obesity plan: interactions between modelled policies Setting out how the policies in chapters 1 and 2 of the government’s childhood obesity plan could work together.

Workforce briefing: winter 2018 This briefing reveals that patient demand is strongly outstripping the supply of doctors as the usual seasonal increase combined with a rise in children’s emergency admissions is placing unprecedented demand on services. It highlights some of the key findings from the College's workforce census 2017 and provides recommendations for the future of the paediatric and child health workforce.

Consultations

Children and young people with disabilities and severe complex needs: integrated health and social care support and service guidance This NICE guidance will cover all settings in which health and social care is provided for disabled children and young people with severe complex needs, including educational settings. As well as looking at integrated health and social care support, it will also aim to ensure that effective commissioning and joint working occur between practitioners across health and social care services. The consultation closes on 5 February 2019.

Bevan Brittan Updates 

How should local authorities capture new local safeguarding arrangements? There have been significant changes to safeguarding legislation recently, but it's fair to say that the impact of the changes has probably not yet been felt. However, the deadline for publishing the new arrangements – 29 June 2019 - is now only six months away.

If you wish to discuss any queries you may have around children please contact Deborah Jeremiah

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Clinical Risk/Patient Safety 

Publications/Guidance 

Safety and learning video - Emma Redfern is a consultant in Emergency Medicine who played a part in saving Graham Papworth’s life back in 2014. They got together recently and made a short video titled ‘My Doctor and me’ for Aortic Dissection Awareness (UK & Ireland) and their UK Think Aorta Campaign. The video is designed to help spread best practice to emergency departments across the UK and globally. It covers some really great joined up team work between departments at UH Bristol, how together they save lives, their caring and professional interaction with the patient and their family and how the staff are trying to share knowledge.

Sign up to safety - Kindness and safety. This talks about the way in which we use the word and why it is important if people are going to work safely.

Telling patients the truth when something goes wrong - Evaluating the progress of professional regulators in embedding professionals' duty to be candid to patients A report by the Professional Standards Authority explores how UK professional regulators have attempted to encourage healthcare professionals to be open and transparent when something has gone wrong in the care they or someone else have provided. It finds: regulators have made progress with initiatives to encourage candour; many of the barriers to professionals being candid remain the same as in 2014; and regulators could create more case studies of candour scenarios to better explain to professionals when to be candid and the regulatory consequences of not being candid.

Opening the door to change, examines the issues that contribute to the occurrence of never events and wider patient safety incidents in NHS trusts in England. This report looks at NHS safety culture and the need for transformation. The review found that too many people are being injured or suffering unnecessary harm because NHS staff are not supported by sufficient training, and because the complexity of the current patient safety system makes it difficult for staff to ensure safety is an integral part of everything we do.

Informed Consent in Healthcare Settings Scottish Parliament A Scottish Parliament briefing explores the law of informed consent, which requires permission for the clinician to treat or examine the patient, and uses the Supreme Court decision of Montgomery v Lanarkshire Health Board, which enhanced protection of patient rights to include information about the risks involved in proposed treatment, and information on alternative treatments, to provide context in light of the Scottish Government's commitment to review the consent process, mental capacity and mental health legislation.

Blowing the whistle: an investigation into the Care Quality Commission’s regulation of the Fit and Proper Persons Requirement The Ombudsman carried out an independent investigation into a whistle-blower’s complaint about the Care Quality Commission’s oversight of the appointment of a chief executive to an NHS trust. It found that, in this case, record-keeping was poor and it did not adequately weigh up the evidence. The report concludes that the Care Quality Commission lacked rigour in its regulation of the appointment of NHS directors and had failed to take a transparent and proportionate approach.

Legislation

Approval of home use for the second stage of early medical abortion Approval of home of a pregnant woman in England who is undergoing treatment for termination of pregnancy as a class of place for second stage of treatment for early medical abortion.

News

RCP says CQC's report on never events should 'sit side by side' with patient safety strategy for the NHS.  The Care Quality Commission’s (CQC) new report, Opening the door to change, should 'sit side by side' with the patient safety strategy for the NHS according to Dr John Dean, RCP clinical director for quality improvement and patient safety.

NHS long-term plan: Focus on prevention 'could save 500,000 lives'

Wide-ranging new maternity plans announced by the government. Mothers and new babies will be offered better support as part of plans designed to make the NHS one of the best places in the world to give birth.

Bevan Brittan Updates

Criminal Prosecutions in Health and Social Care. Criminal prosecutions in the patient safety arena continue to rise, such as this recent case by the Health and Safety Executive against The Priory following the very sad death of 14-year old Amy El-Keria whilst in the care of one of its hospitals in 2012.

Webinars   

Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility.  Just ask Claire Bentley.

If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd or Penelope Radcliffe.

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Commissioning   

Publications/Guidance 

Personal health budgets mandatory data collection: guidance and data These documents provide information for all CCGs in England regarding the completion of the mandatory personal health budgets data collection being implemented on a quarterly basis from July 2018 onwards.

Preparing for 2019/20 Operational Planning and Contracting Annex C: NHS Improvement guidance to trusts for operational plans. This document contains the technical guidance for NHS planning for trusts for 2019/20 operational plans.

Note on CCG allocations 2019/20 to 2023/24. A document setting out the changes made to target CCG allocations for 2019/20, the pace of change rules, and the assumptions used to set the overall CCG allocations growth rate.

A review of the role and costs of clinical commissioning groups (CCGs) This review sets out: changes to the commissioning landscape before CCGs were established; the role, running costs and performance of CCGs; and the changing commissioning landscape and the future role of CCGs.

Preparing for 2019/20 Operational Planning and Contracting. This preparatory guidance covers system planning, the financial settlement, operational plan requirements (for primary care, workforce, data and technology) and the process and timescales around the submission of plans. This is the first part of planning guidance

News 

North East CCGs defeat High Court challenge to transfer of services Sunderland and Tyneside Clinical Care Commissioning (CCG) groups have successfully defended a legal challenge to their plans to transfer stroke, maternity and urgent paediatric care services from South Tyneside hospital to Sunderland. The claimants argued that the consultation process and the assessment of the impact on patients were flawed, but a judge sitting in the High Court in Leeds on 21 December 2018 found for the CCGs.

New resource highlights successful approaches to widen access to end of life care. Commissioners and providers of palliative and end of life care need to take a more proactive approach to tackling inequalities in care to ensure that people of all ages in their diverse local communities receive the support they need according to a new resource.

NHS to be fined for waits over 12 month NHS England has set out plans for clinical commissioning groups (CCGs) and providers of NHS care to face fines of £2,500 for each patient left waiting more than 52 weeks to begin elective treatment. The proposed fine would see CCGs become liable for the first time for financial penalties.

If you wish to discuss the issue of commissioning please contact David Owens.

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Employment/HR  

Publications/guidance

General practice workforce statistics NHS Digital has published the latest data on the general practice workforce covering GPs, nurses, direct patient care and non-clinical staff working in England.

Improving junior doctors' access to educational opportunities This case study describes how Salford Royal NHS Foundation Trust used rota redesign to make improvements around the delivery of education and training within core medical training (CMT). The trust engaged with its junior doctors in order to understand what was needed to accommodate the new three-year curriculum requirements that have replaced the current two-year CMT programme.

Workforce briefing: winter 2018. A briefing from the Royal College of Paediatrics and Child Health warns that patient demand is strongly outstripping the supply of doctors as the usual seasonal pressures combine with a rise in children’s emergency admissions to place unprecedented demand on services.

NHS pension scheme: proposed changes to scheme regulations 2019 The Department of Health and Social Care is consulting on proposals to change NHS pension scheme regulations. Proposed changes include: introducing a new contribution rate of 20.6 per cent for employers from 1 April 2019; renewing current member contribution rates so that the same rates continue to apply beyond 31 March 2019; providing civil partners and same sex spouses with the same survivor pension rights as widows; and extending the current forfeiture of pension benefits rules. The closing date for comments is 28 January 2019.

News

Skill and dedication of NHS staff praised as health service productivity outstrips the rest of the economy

Bevan Brittan Updates

New Immigration Rules And Brexit Increase Recruitment Concerns.  Employers in the UK are facing serious challenges in recruiting the skilled people they need. With job vacancies now at a record high, there are concerns that – BREXIT deal or ‘no deal’ - a more restrictive immigration regime will lead to hiring and retention difficulties staying at critical levels for some time.

Bevan Brittan Training

Bevan Brittan Workforce Forum: Digitisation, Automation and the Healthcare Workforce. Digital modernisation and the warmth of human interaction are both essential for health services to thrive. What changes are we already seeing, what does the future hold, and   how will the workforce have to adapt? 

Combatting sexual harassment training
Bevan Brittan provides organisations with essential training at a range of levels including:-
. Full coverage, workforce-wide training for all grades of employee
. Focussed training for your HR/management teams and
. Board level updates on the key issues and risks.
For more information click here.

If you wish to discuss any employment issues generally please contact Julian Hoskins or James Gutteridge.

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Finance 

Publications/Guidance

Personal health budgets mandatory data collection: guidance and data These documents provide information for all CCGs in England regarding the completion of the mandatory personal health budgets data collection being implemented on a quarterly basis from July 2018 onwards.

A review of the role and costs of clinical commissioning groups (CCGs) This review sets out: changes to the commissioning landscape before CCGs were established; the role, running costs and performance of CCGs; and the changing commissioning landscape and the future role of CCGs.

NHS Payments to General Practice, England, 2017/18. The report provides details on payments to providers of general practice services in England in the past financial year.

Can a strong economic case be made for investing in the NHS? In the 2018 Office of Health Economics Annual Lecture, Professor Peter Smith argues that an economic case can be made for investment in the NHS. But it is not straightforward and will involve changes in the way the NHS thinks about itself. The NHS must show how it can promote the government's macroeconomic objectives, including: sustainable public finances; a stable economy and financial system; structural reforms to increase employment, productivity and growth and preserve international competitiveness; and support for societal wellbeing.

Local Auditor reporting in England 2018. NAO highlights ‘significant weaknesses’ in value for money of NHS and local government This report describes the roles and responsibilities of local auditors and relevant national bodies in relation to the local audit framework and summarises the main findings reported by local auditors in 2017-18. It considers how the quantity and nature of the issues reported have changed since the Comptroller and Auditor General took up his new responsibilities in 2015, and highlights differences between the local government and NHS sectors. According to this report, the number of NHS and local government bodies with significant weaknesses in their arrangements for delivering value for money for taxpayers is unacceptably high and increasing.

How is the NHS performing? December 2018 quarterly monitoring report Eight out of ten NHS trust finance directors say that funding pressures have led to longer waiting times for people who need mental health treatment, finds our latest quarterly monitoring report. This report once more shows that patients are waiting too long for care, and NHS trusts and CCGs remain under tremendous financial pressure. 

Public health grants to local authorities: 2019 to 2020
The public health allocations and monetary conditions for local authorities to improve health in local populations.

New migraine drug not cost-effective says NICE A new drug for preventing migraine is not a good use of NHS resources, according to draft guidance from NICE.

Department of Health and Social Care accounts Key recommendations of the Department of Health and Social Care's 2017/18 Annual Report are: the Department should provide an assessment of the impact of regional variations on patient care; urgent action is needed on the risks that Brexit poses to recruitment and the supply of medical equipment; the NHS 10-year plan must explain how the service will address the many challenges it faces.

If you wish to discuss any queries you may have around finance please contact Claire Bentley.   

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Immigration and health

Publications/Guidance

Overseas NHS visitors: framework to support identification and upfront charging Operational framework on upfront charging, supporting identification and charging of overseas visitors. The framework has been updated throughout. The main change is to emphasise that the longer a patient is expected to remain in the UK, the greater the range of their treatment needs that are likely to be regarded as urgent and therefore not subject to upfront charging (see 6.1). The framework has also been changed to emphasise the importance of clinicians being told by the overseas visitor manager the date on which the patient can reasonably be expected to leave the UK, so that the clinician can decide the urgency of treatment. Four case studies have been added to show this (see 6.3).

The Home Office response to the Independent Chief Inspector of Borders and Immigration's report : An inspection of the Home Office's approach to the identification and safeguarding of vulnerable adults. A Home Office publication sets out its response to the Independent Chief Inspector of Borders and Immigration's report on its approach to the identification and safeguarding of vulnerable adults. It notes that work is already ongoing to identify a consistent definition of vulnerability and support the development of shared guidance for all Border, Immigration and Citizenship System (BICS) staff, and, that under the "Simplification Programme", work is being undertaken to systematically map and assess all guidance for caseworkers in the BICS. The Home Office recognises that investment in new technology cannot be the only solution to the improvement of record keeping, but must be supported by improvements in training, guidance and process.

ECDC guidance on screening and vaccination for newly arrived migrants in Europe. The European Cente for Disease Prevention and Control (ECDC) has published guidance on screening and vaccination for infectious diseases in newly-arrived migrants in Europe, intended to support member states in the development of national strategies [1]. The guidance takes account of the results of systematic evidence reviews, the opinions of an ad hoc scientific panel comprising 21 EU and EEA experts, and the recommendations of an advisory group on which PHE and other UK scientists were represented.

WHO launches technical guidance series on the health of refugees and migrants WHO has launched a technical guidance series on the health of refugees and migrants. Produced in collaboration with the European Commission, each publication addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve their health. Five publications are currently available, each with a special focus on one of the following:
•children’s health;
•health promotion;
•healthy ageing;
•maternal and newborn health; and
•mental health.
This technical guidance series complements the forthcoming “Report on the health of refugees and migrants in the WHO European Region”, which will be published online in the first quarter of 2019.

Legislation

Immigration (Health Charge) (Amendment) Order 2018 (SI 2018/1389). This Order amends the Immigration (Health Charge) Order 2015, which requires a person who applies for entry clearance for a limited period, or for limited leave to remain in the United Kingdom, to pay an immigration health charge. Art.2 amends the 2015 Order to make provision in respect of the exchange rate which the Home Office is to apply when the charge is paid in a currency other than sterling. The exchange rate is to be determined by reference to the Home Office Exchange Rate Policy. Art.3 amends Sch.1 to the 2015 Order, which specifies the annual amount of the immigration health charge in respect of applications by different categories of person. In respect of applications by students, dependants of students and Youth Mobility Scheme Temporary Migrants, the annual amount is increased from £150 to £300. In respect of all other categories of application, the annual amount is increased from £200 to £400. Art.4 makes transitional provision so that the amendments made to the 2015 Order by this Order do not apply to an application for entry clearance or leave to remain made before the Order comes into force.

If you wish to discuss any queries you may have around immigration and health please contact Claire Bentley.   

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Information sharing/data  

Publications/Guidance 

GP premises: the patient perspective Poor confidentiality at reception desks, issues with access for disabled people and dated waiting rooms are some of the biggest problems highlighted by patients in a new report published by the Patients Association.

Identity checking for GP online services. This is a step-by-step guide that will help GP practices to go about checking patients who want to access GP online services.

If you wish to discuss any queries you may have around information sharing please contact Jane Bennett.

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Mental Health 

Publications/Guidance

Discharge conditions that amount to a deprivation of liberty. An HM Prison and Probation Service publication sets out the Secretary of State's position on the discharge of restricted patients on conditions that involve a deprivation of liberty, following the Supreme Court decision in Secretary of State for Justice v MM.

Restraint Techniques: Children and Young People: Written question - 206310.
In response to a written question asking for an update on when the Department plans to publish its response to its consultation on reducing the need for restraint and restrictive intervention, the Department of Health and Social Care stated that it has been working with Department for Education officials to refine the draft guidance following the public consultation and aims to publish the guidance in the Spring 2019.

Informed Consent in Healthcare Settings Scottish Parliament.
A Scottish Parliament briefing explores the law of informed consent, which requires permission for the clinician to treat or examine the patient, and uses the Supreme Court decision of Montgomery v Lanarkshire Health Board, which enhanced protection of patient rights to include information about the risks involved in proposed treatment, and information on alternative treatments, to provide context in light of the Scottish Government's commitment to review the consent process, mental capacity and mental health legislation.

Mental health services for children and young people: Seventy-Second Report of Session 2017-19
A Committee of Public Accounts report states that although there is a welcome focus on improving NHS mental health services for children and young people, there are still significant gaps in the data to monitor progress. It warns that most young people with a mental health condition do not get the treatment they need, and under current NHS plans this will still be true for years to come, while many face unacceptably long waits for treatment. It also notes that tackling mental health issues among children and young people requires significant cross-departmental co-operation, but current approaches do not ensure that this co-operation happens in practice.

Ordinary residence: anonymised determinations 2018
How the department resolves disputes in the health and social care sector when 2 or more local authorities cannot agree responsibility for meeting a person’s eligible needs.

Equality analysis: liberty protection safeguards – Mental Capacity (Amendment) Bill.
This document looks at the positive, neutral and negative effects that new legislation could have on people with protected characteristics and other groups, such as carers.

The Women’s Mental Health Taskforce: final report.
The Women’s Mental Health Taskforce was formed in response to a rise in mental ill health among women. The taskforce’s final report sets out how women’s experience of mental ill health can differ to men’s. It covers: core themes in women’s mental health; the involvement of women with lived experience; principles for service design; and future strategic priorities. The report urges commissioners and providers across the health and care system to take note of the report’s findings and to embed these in their work.

Health matters: reducing health inequalities in mental illness.
Actions that local areas can take to reduce health inequalities experienced by people living with mental illness.

Mental Capacity (Amendment) Bill. 
This Commons Library briefing provides an overview of the Mental Capacity (Amendment) Bill, and the debates and amendments made during the Bills Lords stages, ahead of its Second Reading in the Commons on 18 December 2018.

Cases

Welsh Ministers v PJ [2018] UKSC 66. This appeal considered whether a statutory power to impose conditions amounting to a deprivation of liberty can ever lawfully be ‘implied’ and whether the framework for Community Treatment Orders provides practical and effective protection for patients’ rights under the ECHR rights. It also considered what the scope is of a tribunal’s power to take into account ECHR rights. The Supreme Court unanimously allowed the appeal. The Court declared that there is no power to impose conditions in a Community Treatment Order which have the effect of depriving a patient of his liberty. The Court considered that there is no express power in the Mental Health Act 1983, s 17B(2) to impose conditions which have the effect of depriving a community patient of his liberty. It is a fundamental principle of statutory construction that a power expressed in general words should not be construed to interfere with fundamental rights such as the right to liberty of the person. The Court considered that there is no reason to suppose that Parliament would have included such a power in the Mental Health Act had it been thought of, and argued that a strong indication to the contrary is the fact that Community Treatment Order conditions cannot compel a patient to take his medication. Court’s Press Summary and also see commentary.

VS v St Andrew's Healthcare [2018] UKUT 250 (AAC). The capacity that a patient had to have in order to make a valid application to the First-tier Tribunal in its mental-health jurisdiction should be put as follows: the patient had to understand that they were being detained against their wishes and that the tribunal was a body that would be able to decide whether they should be released.

R. (on the application of CXF) v Central Bedfordshire Council Court of Appeal (Civil Division), 20 December 2018. [2018] EWCA Civ 2852 The Mental Health Act 1983 s.117, concerning the provision of after-care services for patients who were detained for treatment but then ceased to be detained and left hospital, did not apply to a patient on escorted leave of absence from hospital. On the facts, the patient had remained detained for treatment even while on leave of absence, and he could not be said to be in need of after-care services while still being treated.

Secretary of State for Justice v MM Supreme Court, 28 November 2018. [2018] UKSC 60 The Mental Health Act 1983 s.42(2) and s.73(2) did not permit either the First-tier Tribunal or the Secretary of State for Justice to impose conditions amounting to detention or a deprivation of liberty on a conditionally discharged restricted patient, even if the patient consented.

News

Private mental health company faces large fine over death. Private mental health company The Priory is facing a fine of millions of pounds for breaching health and safety laws after 14-year-old Amy El-Keria, who had a history of suicide attempts, died at its Ticehurst House psychiatric hospital in 2012. The company has indicated a guilty plea in what is thought to be the first prosecution of its kind. It will be sentenced on 6 February 2019.

NHS and schools in England will provide expert mental health support. The NHS will work with schools and colleges to make expert mental health support available to a population of more than 470,000 children and young people across England.

CQC to review the use of restraint, prolonged seclusion and segregation for people with mental health problems, a learning disability and/or autism.

Bevan Brittan Updates

Criminal Prosecutions in Health and Social Care. Criminal prosecutions in the patient safety arena continue to rise, such as this recent case by the Health and Safety Executive against The Priory following the very sad death of 14-year old Amy El-Keria whilst in the care of one of its hospitals in 2012.

How can we help?

Fixed fee training packages. We have devised a two-part fixed fee training package to ensure mental health professionals are up to speed with their duties and to enable key managers to proactively manage caseloads. We regularly deliver these sessions to provider and commissioner organisations, including their partner agencies. If you would like more information click here.

Early Intervention Scheme and Triage. Our EIS allows us to help commissioners, providers and care co-ordinators identify packages of care and treatment interventions, for people who lack capacity, that need an appropriate legal framework. If you would like more information click here.

Bevan Brittan Mental Health Extranet 

Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley.   

If you wish to discuss any mental health issues please contact Hannah TaylorSimon Lindsay or Stuart Marchant.  

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Primary Care  

Publications/guidance

General practice workforce statistics NHS Digital has published the latest data on the general practice workforce covering GPs, nurses, direct patient care and non-clinical staff working in England.

GP premises: the patient perspective Poor confidentiality at reception desks, issues with access for disabled people and dated waiting rooms are some of the biggest problems highlighted by patients in a new report published by the Patients Association.

GP partnership review: final report The GP Partnership Review's final report details the findings of the review and makes final recommendations to the Secretary of State for Health and Social Care and to the CEO of NHS England. Recommendations include: opportunities to reduce the personal risk and unlimited liability currently associated with GP partnerships should be taken forward; the number of GPs who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded; and the capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.

Cannabis-based medication: an interim desktop guide. Following the relaxation of laws governing access to cannabis for medicinal use in November 2018, the Royal College of GPs has published a desktop guide which provides practical information to help GPs hold informed discussions and support patients to make decisions around the drug.

Identity checking for GP online services. This is a step-by-step guide that will help GP practices to go about checking patients who want to access GP online services.

NHS Payments to General Practice, England, 2017/18. The report provides details on payments to providers of general practice services in England in the past financial year.

News

Matt Hancock: shake-up of GP IT will remove outdated systems Outdated and frustrating IT systems in GP practices will be replaced with modern technology under widespread changes announced by the Health and Social Care Secretary.  

If you wish to discuss any issues involving primary care please contact Vincent Buscemi.

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Prison Health  

Publications/guidance 

Government Response to the Health and Social Care Committee's Inquiry into Prison Health Department of Health and Social Care A Department of Health and Social Care command paper setting out the Government's response to the Health and Social Care Committee's inquiry into prison healthcare published in November 2018, "Health and Social Care Committee: Prison Health", responds to the individual recommendations made in the inquiry report, acknowledges where more can be done to better meet the needs of those in its care and sets out improvements that are currently underway to tackle key challenges faced by prisons.

If you wish to discuss any queries you may have around prison health please contact Will Pickles.

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Procurement  

Bevan Brittan Updates 

Procurement: IBA Molecular Italy Srl (IBA). The Court of Justice of the European Union (CJEU) recently published its judgment in C-0606/17 IBA Molecular Italy Srl v Azienda ULSS No 3, Regione Veneto, Ministero della Salute, Ospedale dell’Angelo di Mestre.

Procurement: PPN 04/18 Taking account of a supplier’s approach to payment in the procurement of major contracts.

Procurement: Brexit – all bases covered?

If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.

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Providers  

Publications/guidance 

Brexit operational readiness guidance for the health and care system in England Actions that providers and commissioners of health and social care services should take to prepare for, and manage, the risks of a no-deal exit scenario.

NHS Payments to General Practice, England, 2017/18. The report provides details on payments to providers of general practice services in England in the past financial year.

Master indemnity agreement: approved suppliers The Master Indemnity Agreement (MIA) register provides a list of all approved suppliers to NHS organisations.

News 

NHS to be fined for waits over 12 month NHS England has set out plans for clinical commissioning groups (CCGs) and providers of NHS care to face fines of £2,500 for each patient left waiting more than 52 weeks to begin elective treatment. The proposed fine would see CCGs become liable for the first time for financial penalties.

If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.

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Public Health 

Publications/Guidance  

Guidance on musculoskeletal health Public Health England wants health and care staff to promote good musculoskeletal health to patients, families and communities with a focus on prevention, early detection and treatment.

Cardiovascular disease prevention: applying All Our Health This resource aims to help frontline health professionals, team leaders or managers and senior or strategic leaders to prevent ill health and promote wellbeing as part of their everyday practice. It contains evidence and guidance to help health care professionals to prevent heart attacks, strokes and dementia and to improve cardiovascular health.

Annual Report of the Chief Medical Officer, 2018: Health 2040 - Better Health Within Reach. The Chief Medical Officer (CMO)'s 10th annual report considers what the state of the public's health in England 2040 could look like. The CMO accuses the food industry of "failing the public" and not delivering on voluntary targets set by Public Health England, and calls for taxes on foods high in sugar and salt.

Breastfeeding and dental health. Current evidence and core messaging for dental teams and healthcare professionals.

New measles and rubella elimination strategy for the UK PHE has published a new measles and rubella elimination strategy, that maps out how the UK can sustain elimination of measles, rubella and congenital rubella syndrome (CRS) in the future

News  

Sexual health services and the importance of prevention. At a time when some sexually transmitted infections are increasing, reductions in public health spending are resulting in cuts to services that work to promote safe sexual behaviour. Ruth Robertson looks at the data.

If you wish to discuss any queries you may have around public health please contact Claire Bentley.  

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Regulation

Publications/guidance

Telling patients the truth when something goes wrong - Evaluating the progress of professional regulators in embedding professionals' duty to be candid to patients A report by the Professional Standards Authority explores how UK professional regulators have attempted to encourage healthcare professionals to be open and transparent when something has gone wrong in the care they or someone else have provided. It finds: regulators have made progress with initiatives to encourage candour; many of the barriers to professionals being candid remain the same as in 2014; and regulators could create more case studies of candour scenarios to better explain to professionals when to be candid and the regulatory consequences of not being candid.

Opening the door to change, examines the issues that contribute to the occurrence of never events and wider patient safety incidents in NHS trusts in England. This report looks at NHS safety culture and the need for transformation. The review found that too many people are being injured or suffering unnecessary harm because NHS staff are not supported by sufficient training, and because the complexity of the current patient safety system makes it difficult for staff to ensure safety is an integral part of everything we do.

Blowing the whistle: an investigation into the Care Quality Commission’s regulation of the Fit and Proper Persons Requirement The Ombudsman carried out an independent investigation into a whistle-blower’s complaint about the Care Quality Commission’s oversight of the appointment of a chief executive to an NHS trust. It found that, in this case, record-keeping was poor and it did not adequately weigh up the evidence. The report concludes that the Care Quality Commission lacked rigour in its regulation of the appointment of NHS directors and had failed to take a transparent and proportionate approach.

News

CQC to review the use of restraint, prolonged seclusion and segregation for people with mental health problems, a learning disability and/or autism.

If you wish to discuss any queries you may have around regulation please contact Stuart Marchant or Ben Lambert.   

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Social Care  

Publications/Guidance  

Unmet needs: improper social care assessments for older people in England The authors of this report spoke with older people and their relatives in twelve cities and towns across England. Some said that assessors appeared not to understand their disabilities and support needs. In other cases, before beginning an assessment, assessors announced that services would be cut regardless of an individual’s actual need. And in some cases services were denied or cut significantly, affecting older people’s health and wellbeing. The report concludes that older people in England are at risk of not getting adequate assistance to live independent, dignified lives due to uneven assessments for social services.

Ordinary residence: anonymised determinations 2018 How the department resolves disputes in the health and social care sector when 2 or more local authorities cannot agree responsibility for meeting a person’s eligible needs.

News

ICO begins action against care homes for failure to pay new data protection fee. 

If you wish to discuss any queries you may have around social care please contact Stuart Marchant.

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General  

Publications/Guidance

The NHS Long Term Plan. The NHS Long Term Plan outlines some of the ways in which the NHS wants to improve care for patients over the next 10 years. It explains how the ambitions of the plan will be delivered and describes how strategies will be developed by Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) working together with each other, local councils and other partners. In addition to setting out a new service model for the 21st Century, the Plan covers: prevention and health inadequacies; progress on care quality and outcomes; backing NHS staff; digitally enabled care; and maximising taxpayers' investment.

Long term plan: equality and health inequalities impact assessment NHS England has published an “impact assessment” to show how equality duties were considered in developing the NHS long term plan.

Third report on the effect of the NHS Constitution This report set out: the awareness and understanding of the constitution in the NHS; the impact the constitution is having on the NHS; and progress made and areas for improvement to help embed the constitution in the NHS. The Health Act 2009 requires a report into the effect of the constitution to be published every three years.

Handbook to the NHS Constitution for England. Information about the rights and pledges in the NHS Constitution and what these mean for NHS patients and staff.

NHS Constitution for England: resources A collection of guidance and reports relating to the NHS Constitution for England.

NHS continuing healthcare and NHS-funded nursing care Guidance and resources relating to NHS continuing healthcare and NHS-funded nursing care.

Consultations

Assisted dying survey 2019 Royal College of Physicians In February 2019 the Royal College of Physicians will poll its members via email on whether or not there should be a change in the law to permit assisted dying. It last asked its members in 2014, when most wanted the law to remain the same. 

News

Permission given for legal challenge over funding of transgender fertility treatment. The Equality and Human Rights Commission has been given permission to proceed with its judicial review claim over the funding of fertility services for patients undergoing gender reassignment treatment. The EHRC argues that NHS England has an obligation under the National Health Service Act 2006 and equalities legislation to provide gamete retrieval and storage for trans patients.

Video

International Healthcare Opportunities with WHJ and Bevan Brittan

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